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Oxendine Addresses Race And HMO Issues

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NU Online News Service, Jan. 24, 5:08 p.m. – Georgia Insurance Commissioner John Oxendine discussed regulatory work on a settlement of a race-based investigation of ING Life Insurance Company of Georgia, Atlanta, as well as a separate investigation of prompt-payment concerns at Humana Employers Health Care of Georgia Inc.

Oxendine says work on a settlement to resolve an investigation of ING Life of Georgia for charging black policyholders higher premiums than white policyholders is “real close” to a settlement. “It is measured in weeks,” he continues. Points that still must be addressed include attorneys fees and technical points, Oxendine adds.

A spokeswoman for ING Life of Georgia said that she had no new developments to report.

Oxendine also commented on a $400,000 fine levied today against a Georgia affiliate of Humana Inc., Louisville, Ky.

The fine is the largest of its kind in Georgia history, Oxendine says.

Humana also paid a $15,039 prompt-pay fine in 2001, according to the Georgia Insurance Department.

The new fine is based on new reviews, the department says.

Georgia law requires that claims be paid within 15 working days or that a provider or policyholder be notified why a claim cannot be paid, the department says.

Oxendine says that, after an initial examination, companies were given 18 months to come into compliance with the state prompt pay law.

A total of 10 managed care companies other than Humana are under investigation for violation of prompt-pay laws, Oxendine says.

The Georgia department will impose more fines if payments by managed care organizations are not made in a more timely manner, Oxendine says.

Since the department started monitoring claims payments in the fourth quarter of 1999, it has not found 100% compliance at any HMO reviewed.

At Humana, claims handlers have been violating Georgia prompt-pay requirements 10% of the time, and the statistics are actually getting worse, Oxendine says.

The performance of other companies varies, with some getting better, and others worse, Oxendine says.

“I told Humana and other HMOs that in the very near future we will look at them again,” Oxendine says. “I want the fine to get their attention. If $400,000 is not enough, I can make it more and I will.”

Oxendine says he believes that companies can be at 100% compliance because of technology.

He notes that his department treats a late payment as if it were made on time as long as the company includes 18% interest.

Humana consented to the fine, Oxendine says.

Humana issued a statement emphasizing that it has improved its operations since the problems reported by the Georgia department occurred.

“Humana is committed to timely payment of claims with its contracted providers, as well as its employer groups and members,” Humana says. “The company has taken strong measures to resolve claims payment timeliness issues. In 2001, the company tracked a consistent upward trend in compliance with the 15-day payment regulation in Georgia.”


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